Operative neurosurgery (Hagerstown, Md.)最新文献

{"title":"Functional Gonadotroph Adenomas in Male Patients: Clinical Characteristics, Surgical Outcomes, and Hormonal Follow-up.","authors":"Zain Peeran, Robert C Osorio, Mathieu Perez, Aymen S Kabir, Mulki Mehari, Abraham Dada, Aarav Badani, Harmon S Khela, Jacob S Young, Ivan H El-Sayed, Jose G Gurrola, Philip Theodosopoulos, Lewis Blevins, Sandeep Kunwar, Manish K Aghi","doi":"10.1227/ons.0000000000001693","DOIUrl":"https://doi.org/10.1227/ons.0000000000001693","url":null,"abstract":"<p><strong>Background and objectives: </strong>Functional gonadotroph adenomas (FGAs) are rare pituitary neuroendocrine tumors derived from the steroidogenic factor 1 (SF-1) lineage that present clinically with elevated serum levels of follicle-stimulating hormone (FSH) and/or luteinizing hormone (LH). While previous research has predominantly featured female patients, this study specifically aims to better understand the clinical characteristics and postoperative outcomes of FGAs in male patients.</p><p><strong>Methods: </strong>A retrospective review of medical records from a single institution, encompassing 1306 pituitary adenomas, identified 12 male patients who underwent transsphenoidal resection for FGAs.</p><p><strong>Results: </strong>Mean (SD) age was 66.5 (9.4) years. Mean (SD) size was 28.8 (21.6) mm. Preoperatively, all patients exhibited elevated FSH (mean [SD] = 21.9 (7.0) mIU/mL, range = 13.7-34.9 mIU/mL, normal = 1.5-12.4 mIU/mL). Mean (SD) preoperative LH was 6.5 (5.9) mIU/mL (range = 1.3-20.9 mIU/mL, normal = 1.8-8.6 mIU/mL), and it was elevated in 2 patients. 3 patients possessed preoperative testosterone dysfunction (2 with low total and free testosterone, 1 with low total testosterone). All patients were symptomatic preoperatively, with fatigue, headache, and visual problems being the most common. Gross total resection was achieved in 9 patients (75.0%). Postoperatively, mean (SD) FSH was 18.5 (17.8) mIU/mL (range = 0.7-53.6 mIU/mL), and remained elevated in 5 patients. LH remained elevated in 2 out of the 2 patients with elevated preoperative LH. 6 patients (50.0%) were prescribed testosterone gel postoperatively. 41.7% of patients did not report symptoms postoperatively.</p><p><strong>Conclusion: </strong>All patients presented with elevated FSH levels, and a minority also had elevated LH or low testosterone. Surgery led to a reduction in symptomatic complaints in many cases, and the majority achieved gross total resection. Given that most patients continue to exhibit hormonal abnormalities postoperatively, close follow-up and thorough investigation of gonadal dysfunction is essential, as many patients may require ongoing medical management.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645221","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"In Reply: Brachialis to Anterior Interosseous Nerve Transfer: Comprehensive Anatomic Rationale.","authors":"Olga Politikou, Oskar C Aszmann","doi":"10.1227/ons.0000000000001711","DOIUrl":"https://doi.org/10.1227/ons.0000000000001711","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Endoscopic Third Ventriculostomy for Hydrocephalus Management in Patients With Vein of Galen Malformations: 2-Dimensional Operative Video.","authors":"Michael J Stuart, Robert Campbell","doi":"10.1227/ons.0000000000001721","DOIUrl":"https://doi.org/10.1227/ons.0000000000001721","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Letter: Brachialis to Anterior Interosseous Nerve Transfer: Comprehensive Anatomic Rationale.","authors":"Ibrahim Nagmeldin Hassan","doi":"10.1227/ons.0000000000001710","DOIUrl":"https://doi.org/10.1227/ons.0000000000001710","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645223","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Novel and Cost-Effective Technique for Quantitative Measurement of Endoscopic Photogrammetric Model.","authors":"Amedeo Piazza, Megan M J Bauman, Jacopo Bellomo, Fabio Torregrossa, Luciano C P C Leonel, Yuki Shinya, Stephen Graepel, Matteo De Notaris, Alessandro Frati, Michael J Link, Maria Peris-Celda","doi":"10.1227/ons.0000000000001678","DOIUrl":"https://doi.org/10.1227/ons.0000000000001678","url":null,"abstract":"<p><strong>Background and objective: </strong>In skull base surgery, endoscopic endonasal approaches require precise evaluation of the area of exposure and the maneuverability provided by each approach. Current neuroanatomical methodologies for quantifying these parameters primarily rely on computed tomography (CT) scans and neuronavigation systems, which entail significant financial investment. The aim of this study was to develop and validate an innovative, cost-effective methodology using an endoscopic photogrammetric model to measure the exposure area and maneuverability in endoscopic endonasal approaches, offering an accessible alternative to existing techniques.</p><p><strong>Methods: </strong>Six cadaveric specimens were used to validate the accuracy of endoscopic photogrammetric measurements by comparing them with direct measurements. Subsequently, the exposure area, angle of attack, and surgical freedom were analyzed for 3 endoscopic approaches to the parasellar region: contralateral transmaxillary, single-nostril, and double-nostril approaches.</p><p><strong>Results: </strong>Photogrammetric measurements demonstrated a high level of concordance with direct cadaveric measurements, with a mean difference of 0.02 mm as shown in the Bland-Altman plot.In addition, measurements obtained in comparative analysis describing the exposure area and maneuverability of 3 endoscopic approaches were congruent with those reported in existing literature derived using CT scans and neuronavigation systems.</p><p><strong>Conclusion: </strong>To our knowledge, this study is the first to validate endoscopic photogrammetric models as a measurement tool in neuroanatomy. Performing direct measurements on 3D models might eliminate the necessity of expensive CT and neuronavigation systems for volumetric quantification. Our cost-effective methodology allows for the widespread democratization of anatomical quantification within skull base neuroanatomy.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Minimally Invasive Techniques for Intercostal Nerve Transfer: A Technical Note on Thoracoscopic and Robotic Approaches.","authors":"Rohin Singh, Herman Li, Aman Singh, Abigail Loszko, Taylor Furst, Paul L Feingold, Jonathan J Stone","doi":"10.1227/ons.0000000000001715","DOIUrl":"https://doi.org/10.1227/ons.0000000000001715","url":null,"abstract":"<p><strong>Background and objectives: </strong>3Brachial plexus injuries are a devastating and often life-altering event. For patients with flail limb and no intraplexal donors, intercostal (IC) to musculocutaneous nerve transfer allows for restoration of elbow flexion although the surgery can be long with a painful recovery. In this article, we demonstrate a minimal incision video-assisted thoracoscopic surgery (VATS) method and a robotic approach to IC harvesting for nerve to biceps brachii reanimation.</p><p><strong>Methods: </strong>This study was performed on cadaveric donors. We initially used the VATS technique and placed 3 thoracoscopic ports at IC levels 9 and 10. IC nerve 3 was harvested thoracoscopically under direct video visualization. The nerve was carefully neurolysed at the anterior-most edge and exited at the third midaxillary IC space. The nerve to biceps brachii was isolated and neurolysed proximally. The third IC nerve was coapted to the nerve to biceps brachii. On a separate cadaver, we then performed the robotic IC nerve harvest, dissecting out IC nerves 3, 4, and 5.</p><p><strong>Results: </strong>The VATS technique was used to successfully harvest the third IC nerve. The total harvest time of the single nerve was 55 minutes. The robotic intrathoracic approach was used to successfully harvest IC nerves 3, 4, and 5. The average harvest time for each of the 3 nerves was 27 minutes.</p><p><strong>Conclusion: </strong>This demonstrates a cadaveric proof of concept for the minimally invasive intrathoracic approach to harvest IC nerves for brachial plexus injuries through both the VATS and robotic techniques. Future studies are warranted for intrathoracic approaches to reanimate other peripheral nerves.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645224","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Spinal Column Shortening at L1 to Treat Recurrent Tethered Cord Syndrome: View From the Exoscope: 2-Dimensional Operative Video.","authors":"Nicholas Dietz, Abraham Dada, Hunter Yamada, Vardhaan Ambati, Satvir Saggi, Timothy J Yee, Praveen V Mummaneni","doi":"10.1227/ons.0000000000001723","DOIUrl":"https://doi.org/10.1227/ons.0000000000001723","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144645225","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Principles of Stereotactic Surgery: Corrigendum.","authors":"Michael A Jensen, Joseph S Neimat, Panagiotis Kerezoudis, Rushna Ali, R Mark Richardson, Casey H Halpern, Steven Ojemann, Francisco A Ponce, Kendall H Lee, Laura M Haugen, Fiona E Permezel, Bryan T Klassen, Douglas Kondziolka, Kai J Miller","doi":"10.1227/ons.0000000000001712","DOIUrl":"https://doi.org/10.1227/ons.0000000000001712","url":null,"abstract":"","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144629411","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Characterization of Subthalamic Nucleus Boundary and Trajectory Recommendations From a Commercially Available Microelectrode Recording Algorithm During Deep Brain Stimulation Surgery for Parkinson Disease.","authors":"François D Roy, Babak Afsharipour, Aleksandra King, Michelle Waldron, Fang Ba, Aakash Shetty, Tejas Sankar","doi":"10.1227/ons.0000000000001708","DOIUrl":"https://doi.org/10.1227/ons.0000000000001708","url":null,"abstract":"<p><strong>Background and objectives: </strong>Microelectrode recordings (MER) within the subthalamic nucleus (STN) are routinely performed during deep brain stimulation (DBS) surgery for Parkinson disease. Commercially available algorithms have been developed to detect STN boundaries and recommend an optimal DBS lead trajectory based on MER data. We aimed to characterize the variance of a broadly used algorithm's STN border estimates and trajectory recommendations.</p><p><strong>Methods: </strong>MER data from 37 STN-DBS implants in 21 patients were analyzed offline using a semiautomated algorithm making use of oscillatory activity in MER data (HaGuide, Alpha Omega). Software recommendations were computed using the default STN settings across 3 different 'Site Sizes' and 2 'Waiting Times'. For each of the 6 trials, values for the STN Entrance, STN dorsolateral oscillatory region Exit, STN Exit, STN Length, dorsolateral oscillatory region ratio (%), Stimulation Depth, and trajectory recommendations were analyzed.</p><p><strong>Results: </strong>Even with different input parameters, the algorithm's estimates of STN Exit and STN Entrance within the chosen trajectory had low intrasubject variability and were highly correlated with the depth of the final DBS lead as chosen by the clinical team (STN Exit: r = 0.86 and STN Entrance: r = 0.70; both P < .001). However, the algorithm's trajectory recommendations were more sensitive to input parameters, with the algorithm recommending more than 1 trajectory in 42% of implants.</p><p><strong>Conclusion: </strong>Semiautomated identification of STN boundaries by a commonly used algorithm is relatively less sensitive to algorithm input parameters and well-correlated with final STN-DBS lead depth as determined by an expert surgical team. However, algorithm-generated optimal trajectory recommendations are more strongly influenced by input parameters and should be interpreted with more caution during DBS implantation.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602811","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Optimizing Rod Configuration Across Lumbar Pedicle Subtraction Osteotomy Site: Evolution of a High-Volume Deformity Practice.","authors":"David J Mazur-Hart, Winward Choy, Ping-Yeh Chiu, Rithvik Ramesh, Jaemin Kim, Terry Nguyen, Darryl Lau, Aaron J Clark, Vedat Deviren, Christopher P Ames","doi":"10.1227/ons.0000000000001558","DOIUrl":"https://doi.org/10.1227/ons.0000000000001558","url":null,"abstract":"<p><strong>Background and objectives: </strong>Three-column osteotomy (3CO) is a powerful corrective technique in adult spinal deformity. Unfortunately, they carry high complication rates including mechanical complications (MC) of rod fracture and pseudoarthrosis. Owing to the rapidly aging population, this intervention will only increase in use. The optimal construct configuration to minimize MC and maintain radiographic outcomes has not been established. We wished to evaluate the impact of multirod construct across the 3CO level on MC and durability of radiographic outcomes after correction for adult spinal deformity.</p><p><strong>Methods: </strong>Retrospective review of a high-volume deformity practice at an academic institution. Patients with 3CO of the lumbar spine performed by the senior author were identified. Collected data included demographics, body mass index, prior diagnoses to calculate the age-adjusted Charlson Comorbidity Index, operative time, estimated blood loss, length of stay, complications, and radiographic measurements.</p><p><strong>Results: </strong>A total of 196 patients were identified with 78 (39.8%) 4-rod, 24 (12.2%) 5-rod, 54 (27.6%) 6-rod, and 40 (20.4%) 7-rod constructs. There were more MC in the 4-rod constructs (P = .002). This was primarily due to rod fractures (P = .005). There was also a significant loss of lordosis from immediate postoperative radiographs to follow-up radiographs with 4-rod constructs losing 6.2° compared with 1.8° in 7-rod constructs (P = .009).</p><p><strong>Conclusion: </strong>We found that the number of rods across a lumbar 3CO can affect the number of MC. We also found that the number of rods can prevent the loss of lordosis over time after correction. We recommend using a 7-rod construct for lumbar 3CO to minimize MC and loss of lordosis over time.</p>","PeriodicalId":520730,"journal":{"name":"Operative neurosurgery (Hagerstown, Md.)","volume":" ","pages":""},"PeriodicalIF":0.0,"publicationDate":"2025-07-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144602817","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}